Provider Demographics
NPI:1518938406
Name:SCHRADER, JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:SCHRADER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 NW 100TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50325-5329
Mailing Address - Country:US
Mailing Address - Phone:515-270-0351
Mailing Address - Fax:
Practice Address - Street 1:2100 NW 100TH ST
Practice Address - Street 2:STE 100
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50325-5329
Practice Address - Country:US
Practice Address - Phone:515-270-0351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20852207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0210161Medicaid
IA0210161Medicaid
IAA02300Medicare UPIN